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A Hospital Embraces Accountable Care

February 27, 2014
by John DeGaspari
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A CIO talks about the preparation and challenges of the ACO journey

St. Francis Hospital and Medical Center, a 617-bed facility in Hartford and part of St. Francis Care, an integrated healthcare delivery system in central Connecticut, believes embracing ambitious projects. The hospital became an accountable care organization (ACO) under the Medicare Shared Saving Program (MSSP) in January of last year. At the same time, it is in the midst of switching to Epic for its hospital electronic medical record system and, following that, its ambulatory EMR. 

That has kept St. Francis vice president and CIO Linda Shanley very busy; but as an optimist, she is confident that the changes taking place will result in better care for its patients as it meets targets in improved outcomes under the MSSP program.

St. Francis’ ACO began as an initiative to create a health information exchange (HIE). “Then we started going down the ACO route, trying to become an MSSP. We participated in the MSSP program to see how everything was going to work,” Shanley says.

As part of its ACO initiative, St. Francis implemented a software solution, Collaborative Care for ACOs, (supplied by Orion Health), which includes interoperability, longitudinal medical records, analytics and care coordination technologies. The solution captures clinical and claims data and automates MSSP reporting to Medicare.

St. Francis has a large physician hospital organization of about 800 providers; roughly 200 of those employed physicians and the rest community-based physicians of various size practices, including both primary care physicians and specialists. Within that group are about 24 different EMR systems. 

“We needed a mechanism to aggregate the data for patient care,” Shanley says. “Also, as we went on the ACO journey and applied for the Medicare Shared Savings Program, we needed a mechanism to aggregate the data and provide an application where we could coordinate the care for these patients, so we could see how we could impact outcomes, and provide better outcomes for patients.”

Last year was the ACO’s base year, or its first year of reporting data. “Now we have to impact the care to see the changes as we go forward,” she says. As an ACO, St. Francis combines the claims data with its EMR data and hospital data. Shanley notes there are 28 ACO measures, most of which are quality metrics that depend on clinical data. “The only way to do that is to pile that into a database and pull out what you need,” she says.

Care coordinators deliver the data into the hands of the physicians, performing a crucial role because they manage all of the data on a patient, Shanley says. If the numbers suggest patients are straying off course from their care, the care coordinators can reach out and bring them back on track. “It’s all about coordinating the care for that patient.,” she says. They are especially valuable because they cultivate relationships with patients and navigate them to better health, she adds.

Trying to collect all of the data is the biggest challenge, Shanley says. Right now, St. Francis is doing it with one EMR—the hospital. Soon it will start implementing other various EMRs at the physician practices, each one of which will be a challenge. Physicians typically don’t enter all of the data in certain fields, she says, making the job even more difficult. That’s another reason care coordinators perform a critical role: they have the ability to enter data into the care coordination module from a note or someplace other than a discrete data field, she adds. 

Shanley says the participating physicians can use any EMR as long as it has the ability to share data. She acknowledges that the hospital can’t force the physician practices to switch to Epic once it implements the Epic ambulatory system a year from now, but says she will provide them with the mechanism to do so if they decide to do so. 
She notes that St. Francis and Orion have worked closely together to implement the Collaborative Care solution to meet the hospital’s requirements as an ACO, and will see how well it works over the next year. She is confident it will meet her expectations. (She has done a lot of development projects with other vendors as well, and always tries to stretch the capabilities of the solutions, she says.) Over the next year they will improve the system for better care coordination, including using analytics to flag patients falling out of range and providing the data back to the clinician, she says.